Anesthesia Flashcards

Question

Serotonin syndrome

Answer 1

rigidity, tachycardia, sweating, hyperthermia, seizure

Answer 2

Epidural – Sympathetic denervation, only affects sensory, not motor. - Causes vasodilation - Lowers respiratory and cardiac complications post op vs IV narcotics. No effect on mortality - Anesthetic is placed outside the dura, In epidural space - Avoid insertion at T5 or higher, affects cardiac nerves  bradycardia - Thoracotomy T6-T9 - Laparotomy T8-T10 - Morphine causes respiratory depression  use dilaudid - Morphine epidural does not cause hypotension - Lidocaine causes bradycardia and hypotension  Turn off epidural, give fluids, phenylephrine, and atropine if severe - If leg numb: Turn down epidural rate - CI to epidural – elevated intracranial pressure, hypertrophic cardiomyopathy, cyanotic heart disease, aortic stenosis, elevated ICP, systemic infection Epidural hematoma – sudden back pain at epidural site, loss of sensation and motor in extremities. Loss of bowel bladder control. Dx: MRI, Tx: emergent laminectomy Spinal headache – caused by CSF leak after spinal or epidural. Headache is worse with sitting up. Patients prefer to be supine. Tx: rest, fluids, caffeine. Blood patch if persists > 24 hours Spinal anesthesia = motor and sensory blockade. Injected into subarachnoid space= intrathecal space. Must be injected below L2 to avoid spinal cord. Single shot.

Answer 3

Low-risk surgeries confer < 1% risk of myocardial infarction (MI) and include cataract surgery, breast surgery, and endoscopy. Medium-risk surgeries confer a 1-5% risk of MI and include most head and neck surgeries, thoracic surgeries, abdominal surgeries, orthopedic surgeries, and carotid endarterectomy. High-risk surgeries confer >5% risk of MI and include emergent operations, cardiac surgeries, and major vascular surgeries except carotid endarterectomy. Pre-operative 12-lead ECG is recommended for patients with known coronary artery disease, arrhythmia, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease undergoing surgery that is associated with a medium to high risk of peri-operative MI. Percutaneous angioplasty only – wait 2 weeks before surgery Bare metal stent – 4 weeks before elective surgery DES – 6 months Wait 6 weeks after MI before elective surgery

Answer 4

4 METs are climbing a flight of stairs, walking up a hill, walking on level ground at 4 mph, and performing moderate intensity work around the house. Comorbidities with high risk of peri-op cardiovascular events CHF (Highest risk), ischemic heart dz, CVA, DM, ESRD or AKI Cr > 2 If any above  figure out METS - < 4 mets  slow walking, light effort on stationary bike  Need pharmacologic stress test - > 4 mets  climb 1 flight of stairs without stopping, walking uphill 1-2 blocks  No need for testing

Answer 5

Intubated patient with sudden rise of ETCO2: 1. Hypoventilation 2. CO2 embolus 3. Malignant hypothermia 4. Capnothorax MCC hypoventilation (tx= increase TV or RR) Co2 embolus will cause transient rise of ETCO2 with quick fall of ETCO2 - CO2 embolus is most commonly associated with a DROP of end tidal CO2 (lack of blood flow to lungs) -CO2 embolus associated with hypotension -High end tidal CO2 during mediastinal dissection (EG Nissen) is most likely capnothorax (pneumothorax due to pleural tear) -Enlarge tear to avoid tension capnothorax -Place red rubber catheter with one end into pleural tear and other end into abdomen (equalizes pressures) -At end of procedure bring one end outside of abdomen and place to water seal while Valsalva administered -Can also needle decompress intra-operatively – be sure to prep lower chest

Answer 6

Sudden drop of ETCO2: MC disconnected from vent Also, PE or air embolism, or CO2 embolism; cardiac arrest (all have hypotension) Air embolism: trendelenberg (head down) + left lateral decubitus position; hyperventilate

Answer 7

ASA 1 healthy. 2 mild disease Controlled HTN, diabetes, smoker, 3 severe disease, hx of MI, uncontrolled HTN or DM, Controlled COPD. 4 severe disease with threat to life, unstable angina, decompensated CHF, ESRD, cirrhosis. 5, moribound patient, ruptured AAA, saddle embolus. 6 Donor

Answer 8

Induction of pneumoperitoneum stretches the diaphram, which irriates the phrenic nerve, which causes referred pain to the shoulder. C3-5= phrenic nerve

Answer 9

Iatrogenic pneumothorax: pleuritic chest pain, dyspnea, hypoxemia PUnctured apical pleura

Answer 10

-Beta-blockers: continue peri-operatively to reduce cardiac morbidity (can pause if bradycardia, hypotension) -Aspirin: can continue throughout most elective surgical procedures P2Y12 antagonists (clopidogrel, prasugrel, ticagrelor) -Hold typically 1 week before elective surgery after at least 6 months of dual-antiplatelet therapy after percutaneous coronary intervention (at least 1 month if time-sensitive surgery) -Stop clopidogrel at least 5 days before procedure (restart with loading dose) -Stop ticagrelor 3-5 days before surgery Warfarin: hold 5 days before procedure Direct thrombin inhibitor (dabigatran) -If Cr clearance >50 mL/min, stop 1 day before surgery in low risk bleeding; 2 days if high risk bleeding -Cr 30-50: 2 days before for low risk bleeding, 5 days before for high risk bleeding Factor Xa inhibitors (rivaroxaban, apixaban): 48 hours before surgery (24 hours if low risk bleeding); resume 24 hours after in low risk bleeding, 48-72 hours in high risk bleeding

Anesthesia Flashcards

(34 cards)